by Margo Gordon, MD
There is a new JAMA article out that is very telling: “Medical Conspiracy Theories and Health Behaviors in the United States.” It is a must read article for anyone who wonders why the public does not seem to advocate for themselves when it comes to their medical care in the US. The first theory studied in the article states that the FDA is purposely preventing the public from getting natural cures for cancer and other diseases because of pressures from drug companies.Thirty seven percent of those surveyed were believers in this theory.
The article went on to list the top six beliefs (see table), including the hotly debated topic seen frequently about vaccines. Twenty percent believed that doctors government want to continue to vaccinate children even though they know it causes autism. Even for pessimists like me this was a hard pill to swallow. But that old phrase, “Just because you’re paranoid does not mean that you’re crazy,”came to mind. I don’t think any amount of “medical education” would convince these people otherwise. Simply because the fundamental flaw in their thinking is based on trust, not on logic. And it does not take a genius to realize that there are all kinds of reasons not to trust medical care these days.
Drug companies may be hardest hit for public mistrust. After all, we do ask patients to put the pills in their mouth and swallow. Since most patients aren’t medically trained, they have to be able to trust that what they are swallowing is actually doing more good than harm. One can look only as far as a pharmaceutical commercial to see a litany of risks that terrify most consumers. Most people are not educated enough to understand, but clearly people are perceptive enough to realize that these drugs are being marketed to them and big profits are to be made.
Even just incompetency in web design has been enough to deter people from signing up. The lack of people signing up likely has to do with trust-or lack of it-in addition to the heroic efforts required to having to wade through the bureaucratic difficulties. Opponents of the ACA spend inordinate amounts on fear-based commercials to dissuade anyone in the public who may be on the fence about getting Obamacare and trusting the government. And, the business-minded medical lobbyists that swarm the nation’s capitol have effectively manipulated the current system into what it is.
The average American has no concept of the inner workings of the business of healthcare and how manipulated they have been. They just know that they can’t afford it, many lack any decent sort of access to it, and it is just not to be trusted. After all, they know this much-corporations with fat Wall Street stocks and greedy CEO’s are involved. Note to self: It is hard to effectively fight or lobby for one’s healthcare when you are paranoid of the system itself.
Well, let’s talk oncology since that is the first medical conspiracy theory with the most believers. People can see the medical system dysfunction and corporate greed which fuels their mistrust. Many may not know that hospitals
charge facility fees, but in the major 5- star cancer medical centers, they can see the impressive hotel-like structures that are called hospitals where Steinway player pianos in the entrance may greet them. True, many people in more rural or poorer areas of the country may be spared this visual feast, but they are aware of huge profits in the medical industry that they believe can exploit them. Haven’t gotten to the topic of
oncology yet? Neither have they.
The first theory that the FDA is suppressing natural treatments available for cancer certainly is frustrating for any oncologist I am sure. Cancer treatment is certainly extraordinarily complicated with all kinds of risks, and it is hard for the average person to conceptualize. But intuitively I think their distorted logic makes a bit of sense. You have to take off your doctor cap for a minute here and think like the guy who thought Martians were coming in Orson Welles, “War of the Worlds.” If you haven’t heard it then just think of deer in the headlights fear. If you really can’t trust medical care because intuitively (whether you can verbalize it or not) you feel they do not have your interest at heart, then the only course of treatment is to figure it out yourself. Many people have the erroneous idea that “natural” means it is completely “safe” without side effects and that you can just intuitively trust it. Your mother might even have given it to you at one point.
It is well known that Steve Jobs sought alternative treatment for his pancreatic cancer initially. Many in the public idealize Apple computers and the founder who no doubt may think must have had some logical reason for this. After all his revolutionary technology was all quite logical and he is considered a genius of sorts for many.
And if it is natural and available, then you might trust it yourself — certainly not like the major cancer centers whom are unavailable through the narrow networks via Obamacare. Even if you are covered by the cancer center, the severe generic drug shortages of cheap effective cancer drugs just might not be available for you anyway. Many state of the art top cancer centers complain about the shortages.
Bad Outcomes and TV Lawyer Ads
And if you watch enough lawyer commercials you would definitely not want to see a doctor. Faulty hip implants, vaginal mesh lawsuits and of course drug scares fill the airwaves. If you are lucky you can watch a drug commercial followed by a lawyer commercial.
Recently in the news, a 1.2 billion dollar lawsuit for off label use for a well known schizophrenia drug was reversed. The reason had to do with the laws utilized for the case, applied to healthcare facilities, not drug companies. I am not here to comment on the case, only to point out that the government looks ineffective to the public they are supposedly protecting.
And has anyone forgotten the fungal-filled spinal injections that killed and seriously debilitated back pain patients compounded by a Boston based compound pharmacy? The FDA did not look pretty when they explained that they do not regulate compound pharmacies.
So remember the first medical conspiracy theory involves the lack of trust in the government, specifically the FDA. The public, I believe in their paranoia, is telling us that the FDA is incompetent to protect them; they are not trustworthy. I doubt the public has completely forgotten the FDA’s role in a simple steroid injection fiasco. If they can’t protect your “back”- from steroids then how will they ever do with cancer? Their belief that the FDA is hiding natural cancer treatments secondary to drug company pressures clearly indicates their belief that the FDA is not protecting them from drug company’s “harmful” and “unnatural” cancer treatments. First of all drugs can harm, as in the compound pharmacy case, especially when they are not regulated by the FDA. The thinking then can take the shape of the idea that maybe there is something out there that is “natural” and is not harmful (according to this group). It certainly is a wish by the public not to be harmed by their medical care. Imagine that.
The question I have is what kind of cancer are they referring to? Adenocarcinoma, Hodgkin’s lymphoma or the CANCER that is KILLING the US Healthcare system? If you believe in the latter and are worried about your own medical care, the only handy solution may be to just withdraw: Watch Dr. Oz and consult Dr. Google.
Interestingly, the article tells us that the health behaviors of these “conspiracists” are different. Although it may be difficult to make any sweeping generalizations from this small study, I think that it certainly raises the question of whether the American public is struggling with trust of its own healthcare system.
And, What About My Patient?
After reading the JAMA letter today, I was distracted by a patient who was moving to Los Angeles that I referred for ongoing care at one of the specialty clinics at a well known hospital. The hospital web page clearly states the contact info but the patient reported that the hospital staff answering the phones had never heard of the clinic. Then she finally got a phone number that sent her to an unrelated private practice clinic about 45 minutes away from the hospital. For amusement, I mentioned it to their hospital administration medical staff office who were well aware of the error that they were inadvertently sending their patients to some unknown far away clinic. They mentioned the problem had been going on since December and I guess the phone number had just not yet been fixed. Hmmm….So should my patient trust this referral? Should I? Is medical care to be trusted? Is there a cancer of sorts in the US healthcare system fueling conspiracy theorists? And is this a reliable study anyway? Would love to hear your views.
About the author
Margaret Gordon MD is a psychiatrist who graduated from the Karl Menninger School of Psychiatry. She treats a wide range of psychiatric illnesses with a particular focus on psychodynamic psychotherapy. She
has taken interest in healthcare reform and how the instability and disruptions in America’s healthcare system affects the patient.